March 19, 2010

Poke a Finger on the Invisible Hand

Mrs. YDMV and I have been splitting shifts between the home front and the hospital where they managed to pull Connor’s appendix out of a hole they cut in his bellybutton. Nice trick! Beats the heck out of a rabbit in a hat.

On my home shift I was helping the other boy edit a paper on Adam Smith’s Invisible hand. He did a nice job. I was particularly happy to see him using This American Life as a reference. I love that show.

For those of you who would rather have your appendix pulled out of your bellybutton than try to remember what a long dead economist had to say here is a quick A. Smith refresher; individuals acting in their own self interest lead the market to outcomes that are good for everyone. OK maybe that is taking old Adam a little loose but probably not much.

At the hospital it took both the Charming Mrs. YDMV and I three, maybe more, separate and fairly emphatic tries to make it clear we would manage Connor’s blood sugar with his pump and the 'log he is used to using rather than them hanging a slower insulin with their pump in his IV.

In my spare time I have been reading tweets and blogs on blood glucose meter accuracy. As usual my friend Scott has a nice bit. He advocates for lower accuracy margins of error. Another other good friend of the blog (I am shamelessly steeling that good friend of bit from Colbert even at the risk of getting on his list for swiping it) Kerri also writes on the topic today as did Kelly. Careful YDMV readers will recall I wrote a bit the other day that questioned what the heck accuracy is anyway.

I had a conversation on meters just hours before dragging Connor into the ER. In that chat I said I was sure there are folks, like Kerri, who work at diabetes hard enough that the meter accuracy matter in her (and the soon to be adorable BSparl’s) life makes a difference.

If you have read this far without bailing out you may be asking, “What the heck does this have to do with Adam Smith?” Seriously if you are thinking that you need a life - no wait I mean - Good question! Stand by for the kind of BS (not the blood sugar kind) that made me love writing essay question’s in blue books back in college. (Do they still have blue books?)

Don’t just tell the FDA you want accuracy in your diabetes care. Tell the market. Take an invisible 2x4 in Adam Smith’s invisible hand and smack the market up side its invisible head. You want more accurate meters - buy them. Well their strips - Never buy a meter. Let them give you the meter itself.

The market seems to be trying to supply cheap cr*p meters. The FDA has given the OK to boat loads of meters from firms over seas that may or may not meet our desired goals for accuracy. They probably don’t have the same level of phone support and who knows how issues with adverse actions are tracked. I don’t see these things as in myself interest and so we don’t use them.

Scott point out that there is a meter on the market at +/- 10%. We happen to use it. We started for the aesthetics, they made a pink meter and that mattered to a tween girl. We stay for the low blood draw, compact meter size and easy to read screen. In short they (a word that here means WaveSense) made a better product and we for our own self interested reasons use it. If a big wave (nice pun eh?) of people did too then maybe the market would move to something like WaveSense's form factor, accuracy, usability and pinkness. By then I expect WaveSense will have moved on to even more innovative products.

We didn’t let the Doc’s manage Connor’s blood sugar because we felt we could do it better. We didn’t want an insulin we didn’t have experience with in him. We didn’t know its effective time frame in him. We choose to managed his blood because doing so is in our self interest, We stayed with what we know works. Speaking of what we know, we know his pump well. If lots of parents of T1 kids also decline the hospital’s type 1 sugar management and do it well maybe the market (a.k.a. doctors there) will come to see that as a good care option and give up after the second clearly stated decline of their suggested treatment.

Choose well, as we each live Our American Life we are Adam Smith’s invisible hand.

PS speaking of invisible stuff. I have no relationship with WaveSense other than we use their stuff. Well OK I follow them on Twitter too if that counts as a relationship but they don’t say a lot and I am a highly incompetent twitter user. I did once look to see if they were publicly traded and was thinking about buying into their stock but they weren’t public so I was SOL. I have been to the Hospital’s community fundraisers and probably will go again. They did a very nice piece of surgery. They are right to be cautious about BG management. Side effects of reading this blog may include headache, blurred vision. Your dDiabetes May Vary.